estrogen might initiate IBD. However, no UC case
associated with anastrozole has been reported to date.
There is no UC case among 494 Japanese reports of ad-
verse effects of anastrozole between February 2001, when
the drug was started to be used in Japan, and December
2012 (Center of Medical Information, AstraZeneca,
Synchronous onset of CMV colitis and UC was first
reported in 1990 . Since then at least fifteen cases have
been reported by nine authors (Table 1) [18-25]. These
cases were primary infections rather than reactivation of
CMV. During a retrospective survey of the prevalence of
CMV colitis in UC by immunohistochemistry, Kim et al.
made an intriguing finding: identification of CMV colitis
in 8.2% (5/61) of newly diagnosed UC patients . None
of the five cases had inclusion bodies on hematoxylin and
eosin stain; consequently, none of them was diagnosed
with CMV colitis at the time of diagnosis of UC. This
means that a majority of synchronous CMV colitis is
missed in newly diagnosed UC patients in routine prac-
tice. As in Kim et al’s case , involvement of CMV col-
itis in the present case had been missed during her
De novo inflammatory bowel disease is an increasingly
recognized entity: de novo inflammatory bowel disease,
a more common UC than Crohn’s disease, develops after
solid organ transplantation . The incidence of de
novo IBD in the transplanted patients is esti mated to be
ten times the expected incidence of IBD in the general
population . The main risk factor of de novo IBD
has been found to be CMV infection [27-30]. Onyeagocha
et al. investigated the significance of CMV infection on
the development of colitis in a murine system . Murine
CMV (MCMV) infection resulted in lasting elevation of
antibodies to gut commensal bacteria that is observed in
human IBD . Colitis developed following a trigger
(dextran sodium sulfate) in a far more severe form in
MCMV-infected mice than in mice treated by the trigger
alone. They concluded that (latent) CMV infection may
predispose to developing IBD.
We have reported a case in which CMV colitis and UC
synchronously developed. It is plausible that a subset (a
few to se veral per cent) of UC patients develop syn-
chronous CMV infection. Further studies are needed to
elucidate the plausibility.
Written informed consent was obtained from the patient
for publication of this case report and any accompanying
images. A copy of the written consent is available for
review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
MC is a responsible doctor for the patient, undertook barium enema study,
and wrote the report. ST performed colonoscopy. TA contributed to the
acquisition of data. IO performed microscopic studies. All authors read and
approved the final manuscript.
Division of Gastroenterology, Akita, Japan.
Department of Pathology,
Nakadori General Hospital, Akita, Japan.
Received: 15 October 2012 Accepted: 30 January 2013
Published: 2 February 2013
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